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That is why I liked the fact that the House bill provided reimbursement to physicians to provide that type of counseling. Currently they may provide such advice, but Medicare will not pay for the service.

Herein lies some confusion for me. Like you, Jeff, I see no evil in counselling patients on their options & the results of those options. And sometimes that relates to terminal illness, sometimes not.

The experience roadkill describes seems like part and parcel of the responsibility of being a doctor. The doctor dx's the disease; explains the disease; explains the treatment alternatives and the possible results of each alternative. In the case of a terminal illness, this also would often includes length of possible remission, etc.

I'm not entirely sure why one would pay an additional fee for doctors doing this part of their job. This intends no offense to the doctors on this board.

When the discussion goes beyond the purely medical alternatives (in terminal illness), then that should be provided by an attorney and accountant, as that would be their specialty.

This makes me wonder whether someone anticipates that doctors and PAs will no longer have the time per patient to provide this information, due to the patient load?

Or is it because fees will be negotiated to the point that this is a vehicle for providing an additional payment through the health omnibus legislation to offset other downard fee negotiation? Due to the rather "vague" nature of this service, would it not be open to abuse? Could each doctor involved in a case check off the "end-of-life counselling" box & the fee get paid multiple times for the same patient?

Unfortunately, we wouldn't know the answers to my last few questions until the administrative bureaucrats craft the actual rules.

As I've suggested before, couldn't this type of service be provided for through other existing agencies? Here in PA each of our counties has an "Agency on Aging" for assisting elderly on many items. This service could easily fall into that area. And it could be, perhaps, more effectively handled by such agencies before the highly emotional time of imminent death.

Yesterday I lost a dear friend to cancer. She was undergoing treatment for diabetes and a bloodclot in her leg. She was taken to the hospital ostensibly for that, & they discovered she had extensive cancer. She refused chemotherapy which, she was told, would extend her life only by a few months. She had watched several friends die who had chosen chemotherapy, and she had already decided what her choice would be.

G.Clinchy@gmail.com"Know in your heart that all things are possible. We couldn't conceive of a miracle if none ever happened." -Libby Fudim

​I don't use the PM feature, so just email me direct at the address shown above.

McCain said on a morning news show that there are no provisions for health care for illegal immigrants. Therefore Joe Wilson was wrong.

So an illegal walks into an emergency room, are they going to throw them out on the street? We both know the answer to that. No provisions yet is more like it.
I understand this is your guy but come on.

"The longer you let a dog go in the wrong direction the more they think they are going in the right direction" Don Remien.

Sarah Palin gives a speech accusing Obama of trying to pass a plan with death panels. Obama references that lie and is called partisan by the same people who say nothing about Palin's comment. What she has been saying is a lie -- a false statement that she knows is untrue. If someone chooses to lie in making their political attacks, why is it partisan to call them out?

Because Sarah Palin is not President?

Sarah was, perhaps, a refreshing personality in the campaign, but I cannot say that she would have been Presidential material.

OTOH, O's attitude reminds me of Hillary's unprofessional, emotional outburst on her Congo trip. I am also reminded of O's foot-in-mouth statements about Putin, while the new Soviet leader was far more diplomatic. From our President, from our Secretary of State we should be able to expect a level of professionalism, dignity and diplomacy that those positions require.

G.Clinchy@gmail.com"Know in your heart that all things are possible. We couldn't conceive of a miracle if none ever happened." -Libby Fudim

​I don't use the PM feature, so just email me direct at the address shown above.

So an illegal walks into an emergency room, are they going to throw them out on the street? We both know the answer to that. No provisions yet is more like it.
I understand this is your guy but come on.

I don't understand how this applies to healthcare reform. If anyone walks into an ER, now or in the future, they get treated.

Do we want people going to the ER, where it costs $800-$1000 just to say hello, or do we want them going to an $80 doctor visit????

"For everyone to whom much is given, of him shall much be required." -- Luke 12:48

I don't understand how this applies to healthcare reform. If anyone walks into an ER, now or in the future, they get treated.

Do we want people going to the ER, where it costs $800-$1000 just to say hello, or do we want them going to an $80 doctor visit????

That is a major cost that needs to be corrected in the healthcare reform. Fix the ER's with triage to cut out non-emergencies and deportation of illeagal immigrants after their life is saved.

Currently, ER's are filled up with criminal aliens, and those who don't have insurance, and want others to pay their bills for common non-emergency problems. Those hospital write-offs get passed on to the rest of us in higher medical bills, and higher insurance fees.

The real problems in health care can be fixed with industrial engineering, ER triage, enforcing existing laws (deportations), and tort reform. Start with those things, and the other problems will be much more affordable.

Terry Britton, P.E.

Engineers believe that if it isn't broken, it doesn't have enough features yet.

I guess you missed the interviews of Obama's people advocating end of life counseling. Those on that panel being interviewed denied what the published in their literature. They have a hidden agenda, and backtracked and lied about it every time they are called on it.

Every rose has a thorn, and some thorns have flowers. Anytime something involves more government control, it is usually the case of a lot of thorns hidden by one flower presented to the people no matter the political affiliation.

Despite the Fla supreme court and the swift-boating, the last administration won the electoral process by the skin of its teeth, and did not have the majorities in both houses like the current administration does. Yet there were no explanations for anything they rammed through congress, except "trust us, we're from the gov't and need to do this to protect you".

I think the right should be happy that a little spirited speech is all they've had forced upon them so far. They should be VERY happy that the democrats are free thinking and nearly impossible consensus-formers, or else Obama would have EVERYTHING he wants delivered on a platter. The dems have no "hammer". I would indulge Obama a little speech time, in return for giving the opposition such a forum and opportunity to thwart his agenda, like it or not.